Provider Demographics
NPI:1437482445
Name:ADESOKAN, OLUGBENGA
Entity Type:Individual
Prefix:
First Name:OLUGBENGA
Middle Name:
Last Name:ADESOKAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OLD SHORT HILLS RD
Mailing Address - Street 2:57
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1015
Mailing Address - Country:US
Mailing Address - Phone:973-325-0537
Mailing Address - Fax:
Practice Address - Street 1:141 OLD SHORT HILLS RD
Practice Address - Street 2:57
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1015
Practice Address - Country:US
Practice Address - Phone:973-325-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ253152164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse